Spreading retractor

ABSTRACT

A method for retraction useable in joint arthroplasty. The method includes using a joint retractor having a first arm and a second arm. The first arm has a first portion and a second portion and the second arm having a first portion and a second portion. The retractor is inserted into a surgical opening of a patient&#39;s shoulder joint. The second portion of the first arm is placed against the coracoid process and the second portion of the second arm is placed against the resected humerus. The first portions of the first and second arms are hung over the resected tissue to allow exposure of the glenoid.

CROSS-REFERENCE TO RELATED APPLICATION

This application is a divisional application of U.S. Utility patentapplication Ser. No. 12/938,800 entitled “Spreading Retractor”, filed onNov. 3, 2010 by Sarah M. Anthony and claims benefit to U.S. ProvisionalPatent Application Ser. No. 61/345,328 entitled, “Spreading Retractor,”filed on May 17, 2010. Each of these are expressly incorporated hereinby reference in their entireties.

TECHNICAL FIELD

The present invention relates generally to an instrument for use inorthopaedic surgery, and more particularly to an instrument forspreading and retracting muscles, bone, and/or soft tissue duringorthopaedic surgery.

BACKGROUND OF THE INVENTION

During the lifetime of a patient, it may be necessary to perform a totalshoulder replacement procedure on the patient as a result of, forexample, disease or trauma. In a total shoulder replacement procedure, ahumeral component having a head portion is utilized to replace thenatural head portion of the arm bone or humerus. The humeral componenttypically has an elongated intramedullary stem which is utilized tosecure the humeral component to the patient's humerus. In such a totalshoulder replacement procedure, the natural glenoid surface of thescapula is resurfaced or otherwise replaced with a glenoid componentwhich provides a bearing surface for the head portion of the humeralcomponent.

During surgery, first the humeral head is prepared as is known in theart. Then, the surgeon moves to prepare the glenoid. First, it is usefulto inspect the posterior aspect of the capsule and glenohumeral space.The surgeon then releases the posterior capsule from the glenoid rim.This step allows for complete removal of the anterior inferior capsule.Any osteophytes are removed and the tissue is then placed back intophysiologic tension. The surgeon then needs access to achieve finalexposure to the glenoid. However, gaining access to the glenoid during atotal shoulder replacement procedure is challenging. Various “shoe-horn”type retractors have been used to gain access to the glenoid. However,these types of retractors need to be held in place by people during thesurgery, so they increase the number of people who are required to beinvolved in the surgical procedure. Also, because of the shape, theretractors may actually limit exposure to the wound site, giving thesurgeon less access than may be needed or desired.

Therefore, there is a need for an improved retractor that can expose theglenoid with limited number of people having to hold it.

SUMMARY OF THE INVENTION

According to one embodiment of the present invention, a spreadableretractor for use in joint arthroplasty includes a first arm having afirst portion and a second portion. The second portion is movablycoupled to the first portion. Also, the second portion is coupled to afirst retaining member and the retaining member sized and shaped toretain a portion of a coracoid process. The retractor also includes asecond arm movably coupled to the first arm. The second arm having afirst portion and a second portion that is movably coupled to the firstportion. The second portion is coupled to a second retaining member thatis sized and shaped to couple to a resected humerus.

According to another embodiment, a spreadable refractor for use in jointarthroplasty includes a first arm having a first portion and a secondportion that is coupled to the first portion. The second portion is alsocoupled to a first retaining member that is sized and shaped to retain aportion of a coracoid process. The retractor also includes a second armmovably coupled to the first arm. The second arm has a first portion anda second portion that is coupled to the first portion. Also, the secondportion is coupled to a second retaining member that is sized and shapedto abut a resected humerus.

According to yet another embodiment of the present invention, a methodfor retraction useable in joint arthroplasty includes using a jointretractor having a first arm and a second arm. The first arm has a firstportion and a second portion and the second arm having a first portionand a second portion. The retractor is inserted into a surgical openingof a patient's shoulder joint. The second portion of the first arm isplaced against the coracoid process. The second portion of the secondarm is placed against the resected humerus. The first portions of thefirst and second arms are hung over the resected tissue to allowexposure of the glenoid.

BRIEF DESCRIPTION OF THE DRAWINGS

For a more complete understanding of the present invention and theadvantages thereof, reference is now made to the following descriptiontaken in connection with the accompanying drawings, in which:

FIG. 1 is a perspective view of a retractor according to one embodimentof the present invention.

FIG. 2 is a perspective view of the retractor of FIG. 1 shown in anorthopaedic surgery.

FIG. 3 is a view of the retractor of FIG. 1 engaging the coracoidprocess.

FIG. 4 is a flow chart illustrating a method according to one embodimentof the present invention.

FIG. 5 is a perspective view of a retractor according to anotherembodiment of the present invention.

FIG. 6 is a perspective view of a retractor according to yet anotherembodiment of the present invention.

DETAILED DESCRIPTION OF THE DRAWINGS

Embodiments of the present invention and the advantages thereof are bestunderstood by referring to the following descriptions and drawings,wherein like numerals are used for like and corresponding parts of thedrawings.

Turning now to a FIG. 1, a spreadable retractor 10 for use in jointarthroplasty according to one embodiment of the present invention isillustrated. The retractor 10 includes a first arm 12 and a second arm14. The first arm 12 has a first portion 16 and a second portion 18. Thefirst portion 16 is movably coupled to the second portion 18. In thisembodiment, the first portion 16 and the second portion 18 are coupledvia a hinge 20. However, in other embodiments, other coupling mechanismsthat allow the second portion 18 to move relative to the first portion16 may be used. The hinge 20 allows the second portion 18 to be set atan angle θ relative to the first portion 16.

The second portion 18 is coupled to a first retaining member 22. Theretaining member 22 is sized and shaped to retain a portion of acoracoid process (shown in FIG. 2). In the illustrated embodiment, theretaining member 22 is a u-shaped member 24 that is designed to pressagainst the coracoid process. Also, in the illustrated embodiment, theretaining member 22 and the second portion 18 are integral with oneanother. However, in other embodiments, the retaining member 22 may be aseparate part from the second portion 18. In such embodiments, theretaining member 22 may be fixedly coupled to the second portion 18 orthe retaining member 22 may be movably coupled to the second portion 18.In some embodiments, the retaining member 22 may be pivotally coupled tothe second portion 18. In the embodiment where the first retainingmember is not integral with the second portion 18, any known connectionmethod may be used (whether fixedly connecting or movably connecting).

The second arm 14 of the spreadable retractor 10 is movably coupled tothe first arm 12. The second arm 14 includes a first portion 26 and asecond portion 28 that is movably coupled to the first portion 26. Inthe illustrated embodiment, the first portion 26 is coupled to thesecond portion 28 via a hinge 30. However, in other embodiments, othercoupling mechanisms that allow the second portion 28 to move relative tothe first portion 26 may be used. The hinge 30 allows the second portion28 to be set at an angle α relative to the first portion 26.

The second portion 28 is coupled to a second retaining member 32. Thesecond retaining member 32 is sized and shaped to abut a resectedhumerus 54 (shown in FIG. 2). In the illustrated embodiment, the secondretaining member 32 is a disk 34. The flat side of the disk 34 abuts andpresses against the resected humerus (FIG. 2). Also, in the illustratedembodiment, the retaining member 32 and the second portion 28 areintegral with one another. However, in other embodiments, the retainingmember 32 may be a separate part from the second portion 28. In suchembodiments, the retaining member 32 may be fixedly coupled to thesecond portion 28 or the retaining member 32 may be movably coupled tothe second portion 28. In some embodiments, the retaining member 32 maybe pivotally coupled to the second portion 28. In the embodiment wherethe retaining member 32 is not integral with the second portion 28, anyknown connection method may be used (whether fixedly connecting ormovably connecting).

Because both the second portion 18 of the first arm 12 and the secondportion 28 of the second arm 14 are hinged, the second portions 18, 28can be completely rotated about the first portions 16, 26. The angles αand θ can range anywhere from zero (or nearly zero) degrees to 360 (ornearly three hundred sixty) degrees. In other words, the second portions18, 28 of the first and second arms 12, 14 can be rotated almost all theway around the first portions 16, 26. This is useful because it allowsfor the angles α and θ to be adjusted to allow for placement in anylocation. Also, and especially important, is that the hinges 20, 30allow the second portions 18, 28 to be rotated so that the angles α andθ are approximately 270 degrees. This effectively flips the retractor10, so that it can be used on either shoulder. For example, when thesecond portions 18, 28 are at 90 degrees from the first portions 16, 26,the retractor 10 is adapted to be used on the patient's left shoulder.However, using the hinges 20, 30, the second portions 18, 28 can beswung around to an angle of approximately 270 degrees and the retractor10 can be used on a patient's right shoulder. This decreases the numberof instruments that need to be in an instrument set and also lowers thecost, since only one instrument needs to be made.

Referring back now to the first portions 16, 26 of the first and secondarms 12, 14, the first portions 16, 26 include handles 36, 38,respectively. The handles 36, 38 allow the user to grip the retractor10. The first portions 16, 26 of the first and second arms 12, 14 arecoupled together with a pivot pin 40. The pivot pin 40 allows the firstand second arms 12, 14 to pivot relative to one another. The two firstportions 16, 26 are also linked together via a linking mechanism 42. Inthis embodiment, the linking mechanism 42 is located at the distal endand includes ratchets 44. The end of the first arm 12 engages the spacebetween the ratchets 44, locking the first portion 16 of the first arm12 in place relative to the first portion 26 of the second arm 14. Inother embodiments, the second arm 14 may engage the ratchets 44 or botharms 12, 14 may engage the ratchets. Also included between the firstportions 16, 26 of the first and second arms 12, 14 is a biasing member46. In this embodiment, the biasing member 46 is a steel spring thatprovides the resistance necessary between the two arms 12, 14 to engagethe ratchets 44 and hold the arms 12, 14 in place. The tension createdby the biasing member 46 allows the user to let go of the retractor 10and still have the retractor stay in place—freeing up the user's handsto perform other aspects of the surgery.

Turning now to FIG. 2, the retractor 10 is illustrated during use. Asshown, the retractor 10 is placed into the surgical opening 48. Thesecond portions 18, 28 of the first and second arms 12, 14 press againstskin and tissue in order to keep the surgical opening 48 open so as toreveal a patient's glenoid 50. As illustrated in FIG. 3, the secondportion 18 of the first arm 12 engages the coracoid process 52. As shownin FIG. 3, the u-shaped member 24 grasps the coracoid process 52.Returning now to FIG. 2, the second portion 28 of the second arm 14couples to a resected humerus 54 by abutting a bone cover 56 that hasbeen placed on the resected humerus 54. In other embodiments, the secondportion 28 may abut the resected humerus 54 directly.

As is illustrated in FIG. 2, the first portions 16, 26 hang over theside of the refracted skin and tissue. Also, as shown, by having thefirst arm 12 of the retractor couple to the coracoid process, a greaterportion of the glenoid is revealed than in previous designs. Also, sincethe retractor 10 does not abut the glenoid, more of the glenoid isexposed than in prior art designs.

Turning now to FIG. 4, a method for using the refractor 10 according toone embodiment of the present invention will be described. At step s60,the retractor 10 is used. The retractor 10 includes the first arm 12 andthe second arm 14. The first arm 12 has the first portion 16 and thesecond portion 18. The second arm 14 also includes the first portion 26and the second portion 28. At step s62, the retractor is inserted intothe surgical opening 48. The second portion 18 of the first arm 12 isplaced against the coracoid process 52 at step s64. In the presentembodiment, the second portion 18 of the first arm 12 is placed at thebase of the coracoid process 52. In other embodiments, the secondportion 18 of the first arm 12 may be placed against other portions ofthe coracoid process 52. The second portion 28 of the second arm 14 isplaced against the resected humerus 54 at step s66. This includes havingthe second portion 28 abut a surgical cover 56. The first portions 16,26 of the first and second arms 12, 14 may then be placed outside theincision space.

Turning now to FIG. 5, a retractor 70 according to another embodiment ofthe present invention is illustrated. As shown, the retractor 70includes a first arm 72 and a second arm 74. The first arm 72 includes afirst portion 76 and a second portion 78. The second portion 78 is bentrelative to the first portion 76 at an angle β.

The second portion 78 includes a first retaining member 80. The firstretaining member 80 is sized and shaped to abut and press against thecoracoid process. In this embodiment, the first retaining member 80 is aclawed foot 82. The clawed foot 82 is pivotally coupled to the secondportion 78 via a pivot pin 84. The pivot pin 84 allows the clawed foot82 to rotate about the second portion 78 in order to optimize the holdon the coracoid process. In other embodiments in which the clawed foot82 is a separate piece from the second portion 78, other knownattachments may be used. In yet other embodiments, the clawed foot 82may be integral with the second portion 78. Alternatively, the clawedfoot 82 may be a separate piece from the second portion 78, but may befixedly attached to the second portion 78. In other embodiments in whichthe clawed foot 82 is a separate piece from the second portion 78, otherknown attachments may be used.

Turning now to the second arm 74, the second arm 74 includes a firstportion 88 and a second portion 90. The second portion 90 is bentrelative to the first portion 88 at an angle γ. The second portion 90includes a second retaining member 92. The second retaining member 92 issized and shaped to abut and press against the resected humerus 54. Inthis embodiment, the second retaining member 92 is a disk 94. The disk94 includes a cruciform 96 having a spike 98. The spike 98 engages theresected head of the humerus. In this embodiment, the hole made by thespike 98 is not any larger than a hole made by the stem that willeventually be inserted into the resected humerus. In other embodiments,the second retaining member 92 abuts a protective cover (such as the oneshown in FIG. 2) on the resected head and the cruciform 96 and spike 98are inserted into a corresponding recess (or recesses) in the cover. Inyet other embodiments, the spike 98 engages an opening in a broach thatis inserted into the humerus. In such embodiments, the user would broachthe humerus as is known in the art and then leave the broach insertedwhile preparing the glenoid. The user would then insert the spike intothe corresponding opening in the broach, such that the second retainingmember 92 engages the broach and positioning the second retaining member92 against the humerus. In some embodiments, the spike 98 might lockinto an opening in the broach. In other embodiments, the spike 98 maynot be in locked engagement, but instead may only engage the broach.

The disk 94 is pivotally coupled to the second portion 90 via a pivotpin 100. The pivot pin 100 allows the disk 94 to rotate about the secondportion 90 in order to best fit on the resected humerus. In otherembodiments in which the disk 94 is a separate piece from the secondportion 90, other known attachments may be used. In yet otherembodiments, the disk 94 may be integral with the second portion 90.Alternatively, the disk 94 may be a separate piece from the secondportion 90, but may be fixedly attached to the second portion 90. Inother embodiments in which the disk 94 is a separate piece from thesecond portion 90, other known attachments may be used.

Turning now to the first portions 76, 88 of the first and second arms72, 74, the first portions 76, 88 are coupled via a linking mechanism102. In this embodiment, the linking mechanism 102 is a ratchetmechanism that extends from the first portion 76 of the first arm 72.The first portion 88 of the second arm 74 includes a recess (104) forengaging the linking mechanism 102. A locking mechanism 106 engages thelinking mechanism 102 to lock it into place. The locking mechanism 106includes a handle 108 that can be easily engaged by the user to releasethe linking mechanism 102.

Turning now to FIG. 6, another embodiment of the present invention isillustrated. In this embodiment, a retractor 120 is shown. The retractor120 includes a first arm 122 and a second arm 124. The first arm 122 hasa first portion 126 and a second portion 128. The second portion 128 ismovably coupled to the first portion 126. In this embodiment, the firstportion 126 and the second portion 128 are coupled via a hinge 130.However, in other embodiments, other coupling mechanisms that allow thesecond portion 128 to move relative to the first portion 126 may beused. The hinge 130 allows the second portion 128 to be set at an angleφ relative to the first portion 126.

The second portion 128 is coupled to a first retaining member 132. Theretaining member 132 is sized and shaped to retain a portion of acoracoid process (shown in FIG. 2). In the illustrated embodiment, theretaining member 132 is a u-shaped member 134 that is designed to pressagainst the coracoid process. Also, in the illustrated embodiment, theretaining member 132 and the second portion 128 are integral with oneanother. However, in other embodiments, the retaining member 132 may bea separate part from the second portion 128. In such embodiments, theretaining member 132 may be fixedly coupled to the second portion 128 orthe retaining member 132 may be movably coupled to the second portion128. In some embodiments, the retaining member 132 may be pivotallycoupled to the second portion 128. In the embodiment where the firstretaining member is not integral with the second portion 128, any knownconnection method may be used (whether fixedly connecting or movablyconnecting).

The second arm 124 of the spreadable refractor 120 is movably coupled tothe first arm 122. The second arm 124 includes a first portion 136 and asecond portion 138 that is movably coupled to the first portion 136. Inthe illustrated embodiment, the first portion 136 is coupled to thesecond portion 138 via a hinge 140. However, in other embodiments, othercoupling mechanisms that allow the second portion 138 to move relativeto the first portion 136 may be used. The hinge 140 allows the secondportion 138 to be set at an angle ρ relative to the first portion 136.

The second portion 138 is coupled to a second retaining member 142. Thesecond retaining member 142 is sized and shaped to abut a resectedhumerus (shown in FIG. 2). In the illustrated embodiment, the secondretaining member 142 is a curved piece 144. The curved outside of thecurved piece 144 abuts and presses against the humeral shaft below thehead. Also, in the illustrated embodiment, the retaining member 142 andthe second portion 138 are integral with one another. However, in otherembodiments, the retaining member 142 may be a separate part from thesecond portion 138. In such embodiments, the retaining member 142 may befixedly coupled to the second portion 138 or the retaining member 142may be movably coupled to the second portion 138. In some embodiments,the retaining member 142 may be pivotally coupled to the second portion138. In the embodiment where the first retaining member 142 is notintegral with the second portion 138, any known connection method may beused (whether fixedly connecting or movably connecting).

Because both the second portion 128 of the first arm 122 and the secondportion 138 of the second arm 124 are hinged, the second portions 128,138 can be completely rotated about the first portions 126, 136. Theangles φ and ρ can range anywhere from zero (or nearly zero) degrees to360 (or nearly three hundred sixty) degrees. In other words, the secondportions 128, 138 of the first and second arms 122, 124 can be rotatedalmost all the way around the first portions 126, 136. This is usefulbecause it allows for the angles φ and ρ to be adjusted to allow forplacement in any location. Also, and especially important, is that thehinges 130, 140 allow the second portions 128, 138 to be rotated so thatthe angles φ and ρ are approximately 270 degrees. This effectively flipsthe retractor 120, so that it can be used on either shoulder. Forexample, when the second portions 128, 138 are at 90 degrees from thefirst portions 126, 136, the retractor 120 is adapted to be used on thepatient's left shoulder. However, using the hinges 130, 140, the secondportions 128, 138 can be swung around to an angle of approximately 270degrees and the retractor 120 can be used on a patient's right shoulder.This decreases the number of instruments that need to be in aninstrument set and also lowers the cost, since only one instrument needsto be made.

Referring back now to the first portions 126, 136 of the first andsecond arms 122, 124, the first portions 126, 136 include a linkingmechanism 146. In this embodiment, the linking mechanism 146 is locatedat the distal end and includes ratchets 148. The ends of both the firstarm 122 and second arm 124 engage the space between the ratchets 148,locking the first portion 126 of the first arm 122 in place relative tothe first portion 136 of the second arm 124. In other embodiments, thesecond arm 124 may engage the ratchets 148 or both arms 122, 124 mayengage the ratchets. A locking feature 150 is included on the linkingmechanism 146 to lock the arms 122, 124 in position relative to oneanother.

While the invention is susceptible to various modifications andalternative forms, a specific embodiment thereof has been shown by wayof example in the drawings and will herein be described in detail. Itshould be understood, however, that there is no intent to limit theinvention to the particular form disclosed, but on the contrary, theintention is to cover all modifications, equivalents, and alternativesfalling within the spirit and scope of the invention as defined by theappended claims.

The invention claimed is:
 1. A method for retraction useable in jointarthroplasty comprising: using a joint retractor having a first arm anda second arm, the first arm having a first portion and a second portion,wherein the first portion of first arm is hingedly coupled to the secondportion of the first arm, and the second arm having a first portion anda second portion, the first portion of the second arm is hingedlycoupled to the second portion of the second arm; inserting the retractorinto a surgical opening of a patient's shoulder joint; placing thesecond portion of the first arm against a coracoid process; placing thesecond portion of the second arm against a resected humerus; and hangingthe first portions of the first and second arms over a resected tissueto allow exposure of the glenoid.
 2. The method of claim 1, furthercomprises bending the second portion of the first arm and the secondportion of the second arm into a cavity.
 3. The method of claim 1,wherein placing the second portion of the second arm against theresected humerus includes placing the second portion of the second armagainst a bone plate cover that abuts the resected humerus.
 4. Themethod of claim 1, further comprising ratcheting one of the first armand second arm into a position relative to the other of the first armand second arm.
 5. The method of claim 4, further comprising locking thefirst arm into the ratcheted position relative to the second arm.